Early menopause

What it is

Menopause before 45 is called early menopause, and before 40, premature menopause.¹ When the ovaries stop working normally before 40, doctors call it premature ovarian insufficiency (POI). Periods become irregular or stop, and estrogen falls.²

POI is more common than once thought. Newer data put it at about 3.5% of women, compared with the 1% reported in older studies.²

Causes

Early menopause is more likely if it runs in the family, and with an early first period, smoking or being underweight. Chemotherapy, radiotherapy, some hormone medicines and surgery to remove the ovaries can cause it.¹

Signs

The main sign is periods becoming irregular or stopping early. Hot flashes, night sweats, vaginal dryness, poor sleep, low mood or anxiety, lower sex drive and trouble with memory or concentration can come too.¹

How it's diagnosed

POI is diagnosed when someone under 40 has had irregular or missing periods for at least 4 months and a blood test shows a high FSH. One test is now enough, with a repeat only if the result is unclear.² A missed period always needs a pregnancy test first.

Why treatment matters

Losing estrogen early raises the risk of weak bones, heart disease and stroke, and dementia.² That's why hormone therapy is recommended for people with POI until the usual age of menopause, even if they have no symptoms.² The NHS notes that hormone therapy or the combined pill are the main treatments, though some people, such as those with certain breast cancers, can't take hormones.¹

Fertility

POI makes natural pregnancy much less likely, but some people still ovulate now and then, so it's sometimes possible.² Options for having a baby include IVF with eggs frozen earlier or with donor eggs, surrogacy and adoption.¹

When to see a doctor

See a doctor if you're under 45 and your periods become irregular or stop, or you have menopause symptoms.¹ If you've missed periods for 4 months or more under 40, ask about POI.